'Safety at risk until all staff feel able to disclose errors'

Imagine a world where clinicians stood up and spoke about their errors, unafraid of retribution and instead determined to create a health service where those mistakes will not be repeated.

That’s the NHS the health secretary thinks we would have if students were trained to speak out about their concerns and challenge care. He thinks it is something that can and should be taught.

Jeremy Hunt was speaking at the launch of draft joint guidance by the Nursing and Midwifery Council and General Medical Council on the responsibility of individual staff to be honest with patients, colleagues and employers when an incident occurs that harmed - or could have harmed - a patient (see page 5).

This legal duty of candour was recommended by Sir Robert Francis in his report on the care failings at Mid Staffordshire Foundation Trust in February last year.

Nursing Times’ Speak Out Safely campaign, launched last year in the wake of Francis, campaigned for this legal duty of candour to be introduced, so we think Mr Hunt is right. Students should be told that it is fine for them to speak freely about what they see, and should be actively encouraged to look for areas to improve practice.

But is this enough? Nurses can start their shiny new careers with the best of intentions but what if their peers bully them when they challenge practice? Can they really be expected to stand up to more experienced colleagues - and often groups rather than individuals?

The stories we hear tell us we are a long way from concerns being raised as a matter of course. I often talk about bad stories, so here’s one that will give as much hope as the John Lewis Christmas ads.

Last week Bolton Clinical Commissioning Group told me about its incident reporting system. The project was shortlisted for a 2014 Patient Safety and Care Award for Changing Culture, and I interviewed the CCG for a podcast, which will be available on NHS Employers’ website. Associate director of integrated governance and policy Michael Robinson said after introducing it, he witnessed GPs in a room freely admitting their prescribing errors because the system had created a transparent culture to improve quality.

So in some parts of the service, people do feel able to disclose their errors, learn from them and enable their colleagues to learn from them too. But until it’s in all healthcare organisations, patients will not be safe. That’s why it’s vital your organisation signs up to SOS at nursingtimes.net/sos. Check you’re on the list, and if not, sign up today.

Creating national standards for advanced nursing will put an end to the “devaluing” of staff and ensure their skills are recognised equally by all employers, those behind the work have told Nursing Times.

Readers' comments (3)

I wrote a book some years ago about how to provide quality care for older people. I found that since the inception of the NHS the same problems kept recurring. It was because people could not speak out and because we kept making the same mistakes. In the end it was all about culture. I totally agree that we must develop a culture where people can speak out safely without fear. Our patients deserve no less

Jenni is of course right about this, and so is Linda with her 'in the end it is all about culture' comment.

The wider issue here, is about people 'seeing themselves and their own role as somehow 'a special case''.

Everyone agrees, that if HCPs were honest about mistakes, especially in real-time, many complaints would be resolved and would not escalate, and that 'lessons could be learnt and applied'. But if you ask politicians 'to be open about their discussions' you get 'we couldn't honestly discuss things, if the discussions were made public'.

There was someone on the radio last week, who had visited a lot of Care Homes and then written a book. He said something very revealing and very significant:

"The children chose the care homes for their parents - and what the children want for themselves is autonomy, but what they want for their parents is safety".

Wanting 'one thing for yourself, but promoting something different for other people' is a dubious position - for example, should the question re care homes, be 'Is my dad safe here ?', or should you be asking your dad 'Are you enjoying it here ?'.

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